Provider Demographics
NPI:1720361363
Name:CARROLL, CARMEN TIMBES (CPNP)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:TIMBES
Last Name:CARROLL
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:VICTORIA
Other - Last Name:TIMBES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38302-0400
Mailing Address - Country:US
Mailing Address - Phone:731-425-5752
Mailing Address - Fax:731-422-5743
Practice Address - Street 1:2863 HIGHWAY 45 BYP
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3618
Practice Address - Country:US
Practice Address - Phone:731-422-0213
Practice Address - Fax:731-660-8369
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16064363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics